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The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 560 bacterial strains isolated from patients with urinary tract infections (UTIs) in 9 hospitals during the period of June 1997 to May 1998. Of the above bacterial isolates, Gram-positive bacteria accounted for 29.3% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 70.7% and most of them were Escherichia coli. Susceptibilities of several isolated bacteria to antimicrobial agents were as followed; 1. Enterococcus faecalis Ampicillin (ABPC) showed the highest activity against E. faecalis isolated from patients with UTIs. Its MIC90 was 1 microgram/ml. Imipenem (IPM) and vancomycin (VCM) were also active with the MIC90s of 2 micrograms/ml. The others had low activities with the MIC90s of 16 micrograms/ml or above. 2. Staphylococcus aureus including MRSA VCM and arbekacin (ABK) showed the highest activities against both S. aureus and MRSA isolated from patients with UTIs. The MIC90s of them were 1 microgram/ml. The others except minocycline (MINO) had low activities with the MIC90s of 32 micrograms/ml or above. More than a half of S. aureus strains (including MRSA) showed high susceptibilities to gentamicin (GM) and MINO, the MIC50s of 0.25 microgram/ml or 0.5 microgram/ml. 3. Enterobacter cloacae IPM showed the highest activity against E. cloacae. The MICs for all strains were equal to or lower than 1 microgram/ml. The MIC90s of ciprofloxacin (CPFX) and tosufloxacin (TFLX) were 1 microgram/ml, the MIC90s of amikacin (AMK) and ofloxacin (OFLX) were 4 micrograms/ml, the MIC90 of GM was 16 micrograms/ml. Among E. cloacae strains, those with low susceptibilities to quinolones have decreased in 1997, compared with those in 1996. But the other drugs were not so active in 1997 as 1996. 4. Escherichia coli All drugs except penicillins were active against E. coli with the MIC90s of 8 micrograms/ml or below. Particularly, flomoxef (FMOX), cefmenoxime (CMX), cefpirome (CPR), cefozopran (CZOP), IPM, CPFX and TFLX showed the highest activities against E. coli with the MIC90s of 0.125 microgram/ml or below. 5. Klebsiella pneumoniae K. pneumoniae was susceptible to almost all the drugs except penicillins. Carumonam (CRMN) had the strongest activity with the MICs for all strains equal to or lower than 0.125 microgram/ml. FMOX, CPR, CZOP, CPFX and TFLX were also active with the MIC90s of 0.125 microgram/ml or below. The MIC90s of quinolones had changed into a better state in 1997, compared with those in 1996. 6. Proteus mirabilis Almost all the drugs except ABPC and MINO showed high activities against P. mirabilis. CMX, ceftazidime (CAZ), latamoxef (LMOX), CPR, cefixime (CFIX), cefpodoxime (CPDX) and CRMN showed the highest activities against P. mirabilis. The MICs of them for all strains were equal to or lower than 0.125 microgram/ml. CPFX and TFLX were also active with the MIC90s of 0.125 microgram/ml or below. 7. Pseudomonas aeruginosa The MIC90 of GM was 8 micrograms/ml, the MIC90s of AMK, IPM and meropenem (MEPM) were 16 micrograms/ml. The others were not so active against P. aeruginosa with the MIC90s of 32 micrograms/ml or above. The MIC90s of quinolones had changed into a lower state in 1997, compared with those in 1996. 8. Serratia marcescens IPM showed the highest activity against S. marcescens. Its MIC90 was 2 micrograms/ml. GM was also active with the MIC90 of 4 micrograms/ml. The MIC90s of the others were 16 micrograms/ml or above. The MIC50s of CRMN was 0.125 microgram/ml or below, the MIC50s of CPR and CZOP were 0.25 microgram/ml.

Genes that are expressed only in the young zygote are considered to be of great importance in the development of an isogamous green alga, Chlamydomonas reinhardtii. Clones representing the Zys3 gene were isolated from a cDNA library prepared using zygotes at 10 min after fertilization. Sequencing of Zys3 cDNA clones resulted in the isolation of two related molecular species. One of them encoded a protein that contained two kinds of protein-to-protein interaction motifs known as ankyrin repeats and WW domains. The other clone lacked the ankyrin repeats but was otherwise identical. These mRNA species began to accumulate simultaneously in cells beginning 10 min after fertilization, and reached maximum levels at about 4 h, after which time levels decreased markedly. Genomic DNA gel-blot analysis indicated that Zys3 was a single-copy gene. The Zys3 proteins exhibited parallel expression to the Zys3 mRNAs at first, appearing 2 h after mating, and reached maximum levels at more than 6 h, but persisted to at least 1 d. Immunocytochemical analysis revealed their localization in the endoplasmic reticulum, which suggests a role in the morphological changes of the endoplasmic reticulum or in the synthesis and transport of proteins to the Golgi apparatus or related vesicles.

To evaluate the accuracy of pulsed Doppler ultrasound (PDUS) and color Doppler ultrasound (CDUS) for the screening of arterial occlusive disease in the pelvis and lower extremities.We studied 52 patients with intermittent claudication or lower extremity "coolness." Pulsed Doppler waveforms were measured in the inguinal and popliteal regions and were classified according to their pattern. Patients with abnormal waveforms underwent subsequent CDUS evaluation from the aortic bifurcation to the popliteal arteries. All patients also underwent conventional angiography.All stenoses (50%) and occlusions on angiography were detected by PDUS. The combination of PDUS and CDUS allowed detection of 78.0% of stenotic lesions (50% narrowing) and 96.6% of occlusive lesions in the iliofemoral regions and in 100% of stenotic lesions (50% narrowing) and occlusive lesions in the femoropopliteal regions. PDUS required approximately 3 min. About more 5 min are required when CDUS was added.Combined PDUS and CDUS appears to be a rapid, highly sensitive means of screening for arterial occlusive disease in the pelvis and lower extremities.

We study the elliptic-hyperbolic Davey-Stewartson equation which is considered as a nonlocal nonlinear Schrodinger equation with nonlinearities involving derivatives of unknown function in two space dimensions. We show that solutions become analytic for any t/spl ne/0 with respect to x if the data are small and decay exponentially when |x|/spl rarr//spl infin/.

The levels of ten elements in the hair of 7 patients with olivopontocerebellar atrophy (OPCA), 10 patients with late cortical cerebellar atrophy (LCCA) and 1489 healthy persons were determined by inductively coupled plasma emission spectrometry. The phosphorus, zinc, selenium, calcium, magnesium, iron, managanese, aluminium and mercury concentrations did not show any statistically significant difference among the three groups. The copper concentration was significantly lower in the patients with LCCA than in the patients with OPCA, and in the healthy controls. The possibility that LCCA is associated with a mild degree of copper deficiency is considered.

To assess the clinical value of three-dimensional (3D) power Doppler imaging of intratumoral blood flow.Two hepatocellular carcinomas (HCC), one renal cell carcinoma, one hepatic focal nodular hyperplasia (FNH), and one iliac bone metastasis of HCC were used. Images were collected by power mode using the GE-Yokogawa LOGIQ 700. Power Doppler images were recorded on S-VHS videotape and fed into a workstation. Flow information was then extracted, and 3D images were constructed by surface rendering.Preparation of 3D images could be accomplished in one minute after feeding flow information into the workstation. Intratumoral vascular structure could be easily evaluated. This 3D imaging was useful for the differential diagnosis of hepatic tumors, especially HCC and FNH, which were confirmed in 3D imaging to have distinctly different intratumoral vascular structures.3D imaging of intratumoral blood flow was possible by 3D processing of the power Doppler images. 3D power Doppler imaging is expected to be helpful for the differential diagnosis of tumors.

Stent-graft treatment for aortic disease promises to lead to a less invasive therapy than conventional surgical therapy. However, this treatment has not been established as a therapy for aortic dissection. The aim of this study was to examine the effect of stent-graft treatment of aortic dissection, as measured by follow-up data on entry site closure, clotting in the false lumen, and the outcome of the false lumen from the acute to chronic phase after operation.We used a stent-graft of our own design to close the entry site of aortic dissection in 21 cases: 9 were acute (14 days), 8 subacute (6 months), and 4 chronic (6 months). Nine were type A and 12 were type B. In 15 cases, the stent-graft was inserted through the transverse arch, which had been surgically opened under median sternotomy. In the other 6 cases, the stent-graft was inserted by means of a transcatheter through a femoral artery. Using computed tomographic scans, we followed and examined clot formation in the false lumen and reduction in size of the false lumen at 3 levels: at the level of maximum aortic diameter, at the distal end of the stent-graft, and 50 mm distal to the stent-graft. The entry sites were successfully closed in 19 cases (90.4%); in the remaining 2 (both treated with a transcatheter) there was perigraft leakage into the false lumen. The hospital mortality rate of these stent-graft treatments was 14.3% (3 of 21). At 2 weeks after operation, the false lumen had completely clotted, respectively, in 100%, 77%, and 38% of cases at the 3 measurement levels. Substantial shrinkage (50% in diameter) of the false lumen at 6 months after the operation was observed in 72%, 60%, and 38% of cases at the respective levels. Shrinkage of the false lumen was particularly enhanced in patients treated within 6 months from the onset of dissection: The false lumen shrank by50% in 93%, 75%, and 50% of patients.In cases of aortic dissection, the stent-graft is an effective tool for closing the entry site and promoting clot formation in the false lumen and for reducing the size of the false lumen within 6 months of the onset of dissection if the entry site has been closed.

An accurate, reliable, and quick (less than an hour) method for determining the sex of bovine embryos was developed using a fluorescence in situ hybridization (FISH), with a probe designed from a bovine Y chromosome specific DNA (BC1.2). First, to improve a protocol of FISH and evaluate an accuracy of the method, lymphocyte nuclei prepared from three bulls, two cows, and one freemartin were tested. We found that 5 min was enough for hybridization. The washing solution adequate for posthybridization was 0.5x SSC at 72 degrees C for 5 min. The whole procedure for FISH can be accomplished in less than an hour. A male-specific signal was detected, on average, as 97, 0.5, and 83%, respectively, of lymphocytes in males, females, and a freemartin. Using the rapid FISH protocol developed, 28 embryos were divided. According to the presence of the digoxigenin signal, 16 embryos (57.1%) were predicted as male, and 12 embryos (42.9%), predicted as female.

Twenty-four previously untreated patients with a diagnosis of prostatic cancer were treated with chlormadinone acetate (CMA) alone (100 mg/day) for 4 weeks, and luteinizing hormone-releasing hormone analogue (LH-RHa) was added for the next 24 weeks. Marked decreases in blood LH, testosterone (T), prostate specific antigen (PSA), gamma-seminoprotein (gamma-Sm), and prostatic acid phosphatase (PAP) were observed after a single dose of CMA. T levels were significantly increased 3 days after the initial dose of LH-RHa, and did not return to the pretreatment level. There were no significant increases in any of the markers, nor were there any flare-up cases. Triglyceride levels, which were slightly elevated before the start of treatment, were significantly decreased 24 weeks after the completion of combined therapy. PSA was evaluated as partial response (PR) or better in 86.7% of the patients. Overall evaluation showed PR or better in 75.0% of the patients. These findings suggest that prior administration of CMA followed by combined administration with LH-RHa is useful in the treatment of prostatic cancer. No negative effects on lipid metabolism were observed at any time during the treatment period.

Paxillin, a focal adhesion protein, exists as multiple isoforms in humans (alpha, beta, and gamma). To understand more about the physiological role of each isoform, we have employed the mouse system. We found that although the alpha and beta isoforms are present in the mouse, the gamma isoform is not. The alpha isoform protein was detected clearly in most adult tissues, whereas the beta isoform protein was almost undetectable except in spleen, testis, thymus, and lung. On the other hand, mRNAs of both isoforms were detectable in all tissues we examined. High levels of the beta isoform protein was detected in peritoneal exudate macrophage cells in adult mouse as well as in cultured fibroblasts, together with the alpha isoform. The alpha isoform was expressed at a constant level throughout the embryonic stages we examined, whereas the beta isoform protein was detected at the mid-stages of development and increased to levels almost equal to those of the alpha isoform during the late stages of embryogenesis. Therefore, unlike the alpha isoform, expression of the beta isoform protein is restricted in adult tissues. Moreover, we showed that alpha and beta isoforms were colocalized within the same focal adhesion plaques, and cytoplasmic pools of both isoforms exist in the perinuclear area, colocalized with the Golgi apparatus.

A 66-year-old man was admitted to Saiseikai Suita Hospital with stridor and dyspnea. The flow-volume curve showed central airway obstruction pattern. Although a P-A chest roentogenogram was normal, chest tomogram demonstrated a tumor shadow in the lower portion of the trachea. Chest CT examination demonstrated a tumor arising from the posterior wall of the lower portion of the trachea and stenosis with wall thickening extending from the lower portion of the trachea to both main bronchi. Bronchofiberscopic examination revealed polypoid tumors obstructing the lower portion of the tracheal lumen, and biopsy was subsequently performed. On the night immediately after the bronchofiberscopic examination, the patent suddenly choked, and emergency intubation was performed. Adenoid cystic carcinoma was diagnosed on biopsy and we decided to place a spiral Z-stent. A reversed gamma-type stent placement was used. The first spiral Z-stent extended from the trachea to the right main bronchus and the second spiral Z-stent was placed in the left main bronchus through the first stent. Following the spiral Z-stent placement radiotherapy was performed. Spiral Z-stent placement resulted in dilation of the stenotic trachea and both main bronchi.

Susceptibilities to various antimicrobial agents were examined for Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Klebsiella spp., and Pseudomonas aeruginosa that were isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1996 to May 1997, and the results were compared with those obtained during the same period in earlier years. 1. E. faecalis Among E. faecalis strains, those with high susceptibilities to ampicillin and minocycline appeared to have decreased in the latest study period. 2. S. aureus To almost antimicrobial agents, S. aureus isolated from uncomplicated UTIs showed low susceptibilities. But the MIC50s of those agents for S. aureus from complicated UTIs have changed better state. Particularly, the MIC50s of imipenem and clindamycin were 0.125 microgram/ml or below in the latest period for the first time in our history. 3. E. coli The susceptibilities to piperacillin and quinolones of E. coli isolated from uncomplicated UTIs were better than those isolated from complicated UTIs. 4. Klebsiella spp. The susceptibilities to almost antimicrobial agents of Klebsiella spp. have been better during the latest period, compared to those during period of 1995-1996, but to ofloxacin and ciprofloxacin have appeared to have been lower. 5. P. aeruginosa The susceptibilities to quinolones of P. aeruginosa have been better during the latest period compared those during periods of 1995-1996. But, the susceptibilities to cefozopran, carbapenems and monobactams of P. aeruginosa isolated from complicated UTIs appeared to have been lower. These susceptibility changes should be utilized in determining clinical treatments.

A 52 year-old female without any cardiac disease underwent laparoscopic cholecystectomy. Anesthesia was induced with thiamylal and maintained with nitrous oxide and isoflurane. Epidural anesthesia was also used during surgery. When the intraabdominal insufflation was performed in reverse-trendelenburg position 15 minutes after the start of incision, the heart rate suddenly decreased from 75 to 49 bmp with a fall in blood pressure. Her hemodynamic state recovered immediately after the release of intraabdominal pressure and the administration of ephedrine with a rapid infusion of Hespander. The circulatory collapse did not occur when the second insufflation was tried carefully. The circulatory collapse was probably due to the vagal reflex. The decrease in cardiac preload during the reverse trendelenburg position and the epidural administration of local anesthetics may have caused or worsened the circulatory collapse. In anesthetic managements of laparoscopic cholecystectomy using general anesthesia with epidural anesthesia, prophylactic hydrogenation and prevention of parasympathetic domination are important to minimize the vagal reflex.

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 680 bacterial strains isolated from patients with urinary tract infections (UTIs) in 10 hospitals during the period of June 1996 to May 1997. Of the above bacterial isolates, Gram-positive bacteria accounted for 30.4% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 69.6% and most of them were Escherichia coli. Susceptabilities of several isolated bacteria to antimicrobial agents were as followed; 1. Enterococcus faecalis Ampicillin (ABPC) showed the highest activity against E. faecalis isolated from patients with UTIs. Its MIC90 was 1 microgram/ml. Imipenem (IPM) and vancomycin (VCM) were also active with the MIC90S of 2 micrograms/ml. The others had low activities with the MIC90S of 16 micrograms/ml or above. 2. Staphylococcus aureus including MRSA Arbekacin (ABK) and VCM showed the highest activities against both S. aureus and MRSA isolated from patients with UTIs. The MIC90S of them were 1 or 2 micrograms/ml. The others except minocycline (MINO) had low activities with the MIC90S of 32 micrograms/ml or above. 3. Staphylococcus epidermidis ABK and VCM showed the strongest activities against S. epidermis isolated from patients with UTIs. The MICs for all strains were equal to or lower than 2 micrograms/ml. Cefazolin (CEZ), cefotiam (CTM) and cefozopran (CZOP) were also active with the MIC90S of 4 micrograms/ml. Compared with antimicrobial activities of cephems is 1995, the MIC90S of them had changed into a better state. They ranged from 4 micrograms/ml 16 micrograms/ml in 1996. 4. Streptococcus agalactiae All drugs except MINO were active against S. agalactiae. ABPC, CZOP, IPM, and clarithromycin (CAM) showed the highest activities. The MICs for all strains were equal to or lower than 0.125 micromilligrams. Tosufloxacin (TFLX) and VCM were also active with the MIC90S of 0.5 micromilligrams. 5. Citrobacter freundii Gentamicin (GM) showed the highest activity against C. freundii isolated from patients with UTIs. Its MIC90 was 0.5 micrograms/ml. IPM and amikacin (AMK) were also active with the MIC90S of 1 microgram/ml and 2 micrograms/ml, respectively. Cefpirome (CPR) and CZOP were also active with the MIC90S of 8 micrograms/ml. The MIC90S of the others were 16 micrograms/ml or above. 6. Enterobacter cloacae IPM showed the highest activity against E. cloacae. The MICs for all strains were equal to or lower than 0.5 microgram/ml. The MIC90S of ciprofloxacin (CPFX) and TFLX were 1 microgram/ml, the MIC90 of AMK was 2 micrograms/ml, the MIC90S of CZOP, GM and ofloxacin (OFLX) were 4 micrograms/ml. The MIC50S of cephems except CEZ, cefmetazole (CMZ) and cefaclor (CCL) had changed into a better state in 1996, compared with those in 1995. 7. Escherichia coli All drugs except penicillins and MINO were active against E. coli. Particularly CPR, CZOP and IPM showed the highest activities against E. coli. The MIC90S of them were 0.125 microgram/ml or below. Among E. coli strains, those with low susceptibilities to cephems except CEZ, cefoperazone (CPZ), latamoxef (LMOX) and CCL have increased in 1996, compared with those in 1995. 8. Klebsiella pneumoniae K. pneumoniae was susceptible to all drugs except penicillins, with the MIC90S of 2 micrograms/ml or below. CPR had the strongest activity, the MICs for all strains were equal to or lower than 0.25 microgram/ml. Flomoxef (FMOX), cefixime (CFIX), CZOP and carumonam (CRMN) were also active with the MIC90S of 0.125 microgram/ml or below. 9. Pseudomonas aeruginosa All drugs except quinolones were not so active against P. aeruginosa with the MIC90S were 32 micrograms/ml or above. Quinolones were more active in 1996 than 1995. The MIC90S of them were between 4 micrograms/ml and 8 micrograms/ml, and the MIC50S of them were between 1 microgram/ml and 2 micrograms/ml. 10. Serratia marcescens GM showed the highest activity against S. marcescens. Its MIC90 was 1 micro

Clinical background was investigated on patients with urinary tract infections (UTIs) from whom 752 bacterial strains were isolated in 10 hospitals during the period from June, 1996 through May, 1997. 1. Distribution of age and sex of patients and type of infections. Among males, those with ages 40 years or older were more frequent, the higher the ages of them. Among females, those with ages in the 60's were the most frequent (24.6%), and those with ages in the 20's, 40's and 50's were about 13%. With regard to type of infections, more than a half of infections among males with ages 30 years or older were of complicated types, but most of infections among females were of uncomplicated types, especially among females of ages less than 60 years. 2. Ages of patients and types of pathogens. The higher the ages of patients, the lesser became the isolation frequencies of Escherichia coli, but the higher were those of Pseudomonas aeruginosa and Klebsiella spp. 3. Effect of antibiotic use on isolation frequencies of pathogens. Use of antibiotics decreased pathogens isolated from patients with uncomplicated UTIs drastically (231 isolates before antibiotics compared to 60 after). Even isolated pathogens from patients with complicated UTIs decreased drastically with the use of antibiotics when indwelling catheters were not in use (193 isolates before antibiotics compared to 75 after), but when indwelling catheters were in use, antibiotics apparently failed to decrease the isolation frequency. 4. Surgical procedures and types of causative organisms for UTIs. From cases of uncomplicated UTIs, E. coli was the most frequently isolated, followed by Enterococcus Faecalis and Klebsiella spp. E. coli was the most frequently isolated organism from complicated UTIs without indwelling catheters. When a surgical procedures were not done, E. coli was isolated most frequently. From cases of complicated UTIs with indwelling catheters, P. aeruginosa, E. coli and E. faecalis were the organisms that were mainly isolated, with isolation frequencies of 23.2%, 15.2, 12.2, respectively. When no surgical procedures were used, isolation frequencies of P. aeruginosa, E. faecalis and Enterobacter spp. were 17.2%, 13.8%, 13.8%, respectively.

Segmental SMANCS Lipiodol TAE (Seg. SMANCS Lp-TAE) using SMANCS was used to treat HCC in 58 patients and was evaluated in comparison with Seg. Lp-TAE using Epirubicin performed in 50 patients with respect to the course of atrophy of the embolized area, recurrence rate and side effects. On serial CT (Lp-CT) performed after TAE, in cases with P type in which the tumor is present in the periphery of the embolized area and showing Type I homogeneous accumulation of Lp within the tumor, the incidence of atrophy in the embolized area including the tumor was high and the recurrence rate was low. Although no significant difference in the recurrence rate was noted between the groups in which SMANCS and EPI were used, there were more cases with marked atrophy and a lower recurrence rate in the former. No difference was found in post-procedural side effects such as fever between the two groups, while hypotension was rarely observed during the procedure in the group in which SMANCS was used and was easily managed with intravenous steroids. The present results suggest that Seg. SMANCS Lp-TAE is an effective local treatment for HCC limited to a subsegment or segment.

Alzheimer's disease will be one of the main health problems in Japan in the near future, where the proportion of elderly people is showing rapid increase. The causes of the disease have been obscure, but some reports in recent years indicate the intake of aluminum is a risk factor. The reported knowledge concerning the function aluminum, the intake of aluminum and the relationship of aluminum to Alzheimer's disease needs to be summarized. The intestinal absorption of aluminum differs according to its chemical structures, coexistent substances such as maltose, citric acid, silicon and hydrogen ion concentration exponent. Aluminum absorbed from the intestine may be possibly accumulated in the brain tissue. There are some reports which indicate that the aluminum in the brain are toxic to nerve cells and produce Alzheimer's disease-like pathological or biochemical changes in animal brain. While there are a number of epidemiological reports which show that the presence of aluminum in the water supply relates to the disease incidence, it is not well recognized that a large amount of aluminum is contained and can be consumed through commonly used confectioneries and medications. At the present time while the amount of information is not sufficient to make some proposals about the aluminum consumption through foods and medicines, it is sufficient to merit informing people of their intake of the metal so as to be able to make their own decision. For further recommendations, more studies on this problem are necessary.

We report a case of a postoperative brain infarction, in which an asymptomatic preoperative brain infarction was also revealed postoperatively. A 63-year-old man with bladder carcinoma was scheduled for the cystoplasty. The patient had no prominent preoperative abnormality. Anesthesia was maintained with isoflurane in N2O/oxygen combined with a spinal block and a continuous epidural block. Anesthesia lasted uneventfully for 16.5 hours. However, emergence from anesthesia was delayed. On the first postoperative day, motor aphasia and right hemiparalysis was confirmed. The computed tomography (CT) of the brain demonstrated a low density area in the frontoparietal region. The magnetic resonance imaging (MRI) indicated the corresponding lesion as the CT had demonstrated, and an old brain infarction in the parietal region. This meant that the patient had a history of asymptomatic brain infarction (ABI). Patients with ABI are considered to be a high-risk group for a brain infarction. It is important to evaluate the risk factors of brain infarction preoperatively and to minimize those risks during the operation. Maintenance of the cerebral perfusion pressure is imperative.

A perioperative anesthetic management of a 69 year old woman with acromegaly whose clinical course was characterized by severe heart failure is described. The patient showed symptoms of massive cardiomegaly. Endocrine studies indicated that her pituitary tumor was active with hyperproduction of growth hormone. There was no demonstrable evidence for other known causes of heart disease. Following hormonal therapy using continuous subcutaneous infusion of somatostatin for about two months, there was improvement in daily activity and reduction in heart size. After the improvement of cardiac function, transsphenoidal hypophysectomy was performed under general anesthesia and its perioperative course was quite uneventful. We conclude that because cardiac involvement such as left ventricular dilatation in acromegaly might be reversible with proper treatment, any surgical procedure, as long as the case is elective, should be considered after hormone therapy.

Susceptibilities to various antimicrobial agents were examined for Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa that were isolated from patients with urinary tract infections (UTIs) in 11 hospitals during June, 1995 through May, 1996, and the results were compared with those obtained during the same period in earlier years. 1. Macrolide resistant E. faecalis isolated from uncomplicated UTIs during the latest study period appeared to have increased compared to those in previous study periods. More than 50% of the isolated E. faecalis during the latest study period were resistant to macrolide antibiotics, for the first time in our history. 2. No obvious changes were observed through the years for susceptibilities of S. aureus to various antimicrobial agents. Vancomycin (VCM) showed the highest activity against S. aureus, with MICs below 2 micrograms/ml or below. 3. Among E. coli strains, those with low susceptibilities to quinolones appeared to have increased over the years with MIC90 changed from between 0.125 microgram/ml or below and 0.5 microgram/ml in the 1989-1990 period to between 8 micrograms/ml and 128 micrograms/ml in the latest study period. 4. Klebsiella spp. showed higher resistance to most antimicrobial agents during periods of 1993-1994 and 1994-1995, but somewhat lower resistance during period of 1995-1996. No resistant Klebsiella spp. were detected from uncomplicated UTIs during the latest study period. 5. Among P. aeruginosa isolates from complicated UTIs, resistance isolates to gentamicin appeared to be increasing over the years. Resistant strains to quinolones were isolated at lower frequencies during periods of 1991-1994, but higher frequency was observed in the latest period, and MIC50s were between 0.5 and 4 micrograms/ml during 1991-1994, but were 16-32 micrograms/ml during 1995-1996. These susceptibility changes should be utilized in determining clinical treatments.

To clarify the optimal dose of Lipiodol (Andre Guerbet, Aulnay-sous-Bois, France) during Lipiodol-transcatheter arterial embolization (L-TAE) and segmental L-TAE used to treat hepatocellular carcinoma, we studied the relationship between the volume of Lipiodol used during these procedures and the necrosis rates in resected specimens, as well as the correlation with the Lipiodol accumulation pattern based on the computed tomography findings (L-CT) and the volume of Lipiodol in resected and nonresected cases after L-TAE or segmental L-TAE. The L-CT and the dose of Lipiodol injected (mL) were studied correlatively in 198 cases (28 resected cases and 170 nonresected cases; tumor sizeor = 5 cm in 52 cases and5 cm in 118 cases) that underwent L-TAE and in 80 cases (14 resected cases and 66 nonresected cases, tumor sizeor = 5 cm in 52 cases and5 cm in 14 cases) that underwent segmental L-TAE. The L-CT was classified into four types: type I, homogeneous accumulation (type Ia, accumulation around the tumor; type Ib, no accumulation around the tumor); type II, partial defect; type III, sporadic accumulation; and type IV, punctate or no accumulation. In the 42 resected cases (L-TAE, 28 cases; segmental L-TAE, 14 cases), type I was seen in 68% (Ib, 100%) of the L-TAE cases and 93% (Ia, 79%; Ib, 14%) of the segmental L-TAE cases. The necrosis rate of the cases with type Ib L-CT was 90% to 100%, and all type Ia cases showed complete necrosis. In the 236 nonresected cases (L-TAE, 170 cases; segmental L-TAE, 66 cases), the volume of Lipiodol injected correlated with the L-CT type. In the L-TAE cases with a tumor sizeor =5 cm, the frequency of the injected Lipiodol volume (D) being greater than the tumor diameter (d) (Dor = d) was 90%, and 87% of the cases with Dor = d showed type Ib L-CT. In the group whose tumor diameter (d) was more than 5 cm, the frequency of Dor = d was 25%, and 70% of the cases of Dor = d were type Ib. The frequency of Dd was 75%, and in 13% of these cases the L-CT was type Ib and the maximum dose was approximately 10 mL. In segmental L-TAE using the same dose of Lipiodol as in L-TAE, the frequency of Dor = d was 83%, and 93% of those cases showed type I, including 85% of type Ia. There was a correlation between the L-CT type and the necrosis rate, and type I, especially Ia in segmental L-TAE, showed complete necrosis in almost all cases. In L-TAE, standards for the optimal dose of Lipiodol are thought to be as follows: Dor = d in cases with dor = 5, and slightly Dd and 10 mL maximally in cases with d5. In segmental L-TAE using the same dose of Lipiodol as in L-TAE, enhancement of the therapeutic effect was seen compared with L-TAE. This is surmised to have been because of the higher Lipiodol volume with anticancer agents per unit volume of the tumor in segmental L-TAE.

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 704 bacterial strains isolated from patients with urinary tract infections (UTIs) in 11 hospitals during the period of June 1995 to May 1996. Of the above bacterial isolates, Gram-positive bacteria accounted for 29.8% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 70.2% and most of them were Escherichia coli. Susceptibilities of several isolated bacteria to antimicrobial agents were as followed; 1. Enterococcus faecalis Ampicillin (ABPC) and imipenem (IPM) showed the highest activities against E. faecalis isolated from patients with UTIs. The MIC90S of them were 1 microgram/ml. Vancomycin (VCM) and piperacillin (PIPC) were also active with the MIC90S of 2 micrograms/ml and 4 micrograms/ml, respectively. The others had low activities with the MIC90S of 16 micrograms/ml or above. 2. Staphylococcus aureus including MRSA VCM showed the highest activities against S. aureus isolated from patients with UTIs. Its MIC90 was 1 microgram/ml against both S. aureus and MRSA. Arbekacin (ABK) was also active with the MIC90 of 2 micrograms/ml. The other except minocycline (MINO) had very low activities with the MIC90S of 64 micrograms/ml or above. 3. Staphylococcus epidermidis ABK and MINO showed the strongest activities against S. epidermidis isolated from patients with UTIs. The MIC90S of them were 0.25 microgram/ml. VCM was also active with the MIC90 of 1 microgram/ml. The MIC90S of cephems ranged from 2 micrograms/ml to 16 micrograms/ml in 1994, but they ranged from 8 micrograms/ml to 128 micrograms/ml in 1995. These results indicated that some resistances existed among S. epidermidis to cephems. 4. Streptococcus agalactiae All drugs except gentamicin (GM) were active against S. agalactiae. ABPC, cefmenoxime (CMX), IPM, erythromycin (EM), clindamycin (CLDM) and clarithromycin (CAM) showed the highest activities. The MICs for all strains were lower than 0.125 microgram/ml. The MIC90S of the others were 2 micrograms/ml or below. 5. Citrobacter freundii IPM showed the highest activity against C. freundii isolated from patients UTIs. Its MIC90 was 1 microgram/ml. GM was also active with the MIC90 of 2 micrograms/ml. Cefpirome (CPR), cefozopran (CZOP) and amikacin (AMK) were also active with the MIC90S of 4 micrograms/ml. Penicillins and cephems except CMX, CPR and CZOP showed low activities with MIC90S of 256 micrograms/ml or above. 6. Enterobacter cloacae IPM showed the highest activity against E. cloacae. The MICs for all strains were equal to or lower than 1 microgram/ml. MINO and tosufloxacin (TFLX) were also active with the MIC90S of 8 micrograms/ml. Penicillins and cephems except CPR and CZOP showed lower activities with the MIC90S of 256 micrograms/ml or above. 7. Escherichia coli. Most of the antimicrobial agents were active against E. coli. Particularly CPR, CZOP and IPM showed the highest activities against E. coli. The MICs for all strains were equal to or lower than 0.5 microgram/ml. CMX and TFLX were also active with the MIC90S of 0.125 microgram/ml or below. Penicillins were slightly active with MIC90S of 128 micrograms/ml or above. 8. Klebsiella pneumoniae K. pneumoniae was susceptible to all drugs except penicillins, with MIC90S of 2 micrograms/ml or below. Carumonam (CRMN) had the strongest activity against K. pneumoniae, the MICs for all strains were equal to or lower than 0.125 microgram/ml. Comparing with the result of 1994, the sensitivities of K. pneumoniae against all drugs had obviously changed into a better state. For example, the MIC90S of cephems ranged from 0.25 microgram/ml to 16 micrograms/ml in 1994, but they were all lower than 2 micrograms/ml in 1995. 9. Proteus mirabilis P. mirabilis was susceptible to a majority of drugs. CMX, ceftazidime (CAZ), cefixime (CFIX), and CRMN showed the highest activities against P. mirabilis isolated from patients with UTIs. MICs of CRMN for all

Clinical background was investigated on patients with urinary tract infections (UTIs) from whom 785 bacterial strains were isolated in 11 hospitals during the period from June, 1995 through May, 1996. 1. Distributions of age and sex of patients and type of infections. Among the patients examined, those with ages 50 years or older were the most frequent (males: 80.5%, females: 69.7%), and, among females, those with ages in the 20's were 12.6%. With regard to types of infections, more than a half of infections among males were of complicated types, but most of infections among females were of uncomplicated types, especially among females of ages less than 60 years. 2. Ages of patients and types of pathogens. The higher the ages of patients, the lesser became the isolation frequencies of Proteus spp. and Serratia spp., but the higher were those of Klebsiella spp. and Pseudomonas spp. 3. Effect of antibiotic use on isolation frequencies of pathogens. Use of antibiotics decreased pathogens isolated from patients with uncomplicated UTIs drastically (237 isolates before antibiotics compared to 33 after). Even isolated pathogens from patients with complicated UTIs decreased drastically with the use of antibiotics when indwelling catheters were not in use (200 isolates before antibiotics compared to 83 after), but when indwelling catheters were in use, antibiotics apparently failed to decrease the isolation frequency. 4. Surgical procedures and types of causative organisms for UTIs. Escherichia coli was the most frequently isolated organism from uncomplicated cases of UTIs. From cases of complicated UTIs without indwelling catheters, Enterococcus faecalis was the most frequently isolated, followed by E. coli, P. aeruginosa and Klebsiella spp. When a surgical procedures were not done, E. coli was isolated most frequently. From cases of complicated UTIs with indwelling catheters, P. aeruginosa, E. faecalis and S. aureus were the organisms that were mainly isolated, with isolation frequencies of 23.9%, 17.3% and 12.7%, respectively. When no surgical procedures were used, isolation frequencies of P. aeruginosa, Klebsiella spp. and E. faecalis were 25.7%, 14.3% and 14.3%, respectively.

Hemolytic uremic syndrome (HUS) in childhood is recognized as the most frequent cause of acute renal failure and is greatly associated with verotoxin-producing E. coli (VTEC) infection. Most of the prodromal feature in HUS associated with VTEC infection is hemorrhagic colitis (HC). HC progresses to HUS in several days. So it is important to detect whether the patient with bloody diarrhea is associated with VTEC infection or not. From 1992 to 1996 we analyzed clinical findings of 80 HUS and 29 HC patients. High level of beta 2-microglobulin (BMG) and N-acetyl-D-beta-glucosaminidase (NAG) in the urine were observed in the early stage of the disease. We went on to examine verotoxin (VT2)-binding in mouse (ICR) renal sections by enzyme immunoassay. Specific binding of VT2 to tubules was seen in mouse kidney, and intravenous injection of VT2 to mice caused acute tubular necrosis in 15 h whereas glomeruli were intact. These data suggest that the primary target cell of VT2 was tubules in the kidney of the HUS patients with VTEC infection.

We presented a report on an appropriate inspection and test method for static control shoes using ithe test procedures described in JIS and EC standards, with the title, "Control of Static Charge on Personnel (Part 1)" at the 5th ESD Symposium of Japan in 1996. The work has continued in this examination of the effect of static dissipative floors for control of static charge on personnel in combination with conductive shoes. It is obvious that both dissipative floor and conductive shoes must be used together to control static charge generation on people. However, much of the industry relies on individual test methods for floors and shoes without considering the performance of the combined materials.

As a complimentary research project to the demonstration project of 5MW and 1MW PAFC plants, the mechanism and rate of deterioration of the cells and stacks have been studied from 1995 FY, with the objective of establishing an estimation method for the service life-time of the cell stacks. This work has been performed in the Basic Research Project, as part of that project on PAFC`s, selecting four subjects (Electrocatalysts degradation, Electrolyte fill-level, Cell material corrosion, Electrolyte loss) as the essential factors relating to the life-time. In this report, we will exhibit the effect of the electrolyte fill-level on the electrode performances.

To clarify the correlation between the histopathological findings and MR signal intensity of the cyst wall, fifteen cystic metastatic brain tumors of eleven patients were imaged using a 0.5T MR unit just before surgery, and the MRI findings were correlated with the histopathological findings of resected lesions. On T2-weighted images, all cyst walls showed hypointensity. On T1-weighted images, the intensity of the cyst wall could be classified into three groups, compared with the cerebral cortex. Walls with hyperintensity on T1WI(group H; n = 6) consisted of ample tumor cells, blood vessels and connective tissues, suggesting viable tumor cells. Iso-intense walls on T1W1(group I; n = 3)had abundant reactive glial tissues. Hypointense walls on T1W1 (group L; n = 5)revealed hemorrhage and/or hemosicerin in the wall, suggesting hemorrhagic necrosis. Thus a good correlation was demonstrated between the MR signal intensities and histopathological findings of cyst walls of cystic metastatic brain tumors. This may contribute not only to more precise diagnosis on MRI but also to more planning for treatment of cystic brain metastases.

There are numerous psychosocial problems with home care for terminal cancer patients. We studied one case from the viewpoint of providing support for cancer patients and their families. Psychosocial problems are important for the life of cancer patients and their families. The cancer diagnosis and the terminal stage have different levels of psychosocial concerns. We must consider effective intervention with such psychosocial support. (1) The team delivery of health care in oncology is more crucial than ever. (2) Social work plays a key role. (3) We should strive to understand the roles of other members of teams. (4) Members of a support team should take turns in providing care according to the psychosocial conditions of the patients. (5) Sympathy and a broad social outlook are required of medical staff members.

The decision of stopping cardiopulmonary resuscitation (CPR) in patients brought to emergency room in arrest remains a challenge. Such decision is even more difficult when someone is brought by bystanders, after an acute loss of consciousness without any out-of-hospital care. To evaluate the probability of survival of these patients we reviewed retrospectively charts in our institution, during a period of five years.One hundred and one patients that fulfilled these characteristics came to our emergency in arrest. The time to arrival since symptoms started, cardiac rhythm at first electrocardiogram (EKG), age, gender, initial CPR success, late outcomes and previous diseases were obtained. Patients were divided in two groups regarding which cardiac rhythms they had at first EKG: A-patients arriving in asystole; and VF-patients arriving in ventricular fibrillation. To evaluate time to arrival, we arbitrarily choose 15 min as a reference point.In these 101 subjects the mean age was 62 +/- 13.7 years and 63 (62.3%) were men. Previous heart disease was documented in 74 [dilated cardiomyopathy in 22 (21.7%), coronary heart disease in 41 (40.6%), arterial hypertension in 25 (24.7%) and others in 6 (5.6%)]. In 66 episodes we were sure of the time patients spent before arrival (mean 2.5 +/- 11 min). Only in 63 subjects we had no doubts about the rhythm at entrance: VF in 37 (58.7%), A in 22 (34.9%) and an accelerated idioventricular rhythm (AIR) in four (6.3%). Time to arrival was 18.6 +/- 10.6 in VF vs 32.5 +/- 11.7 min in A (p = 0.012). Fourteen (13.8%) subjects resumed a supraventricular rhythm with systolic pressureor = 90 mmHg after CPR and all of them were in VF (13) or AIR (one). Nine patients (8.9%) evolved in coma. Only five (4.9%) were discharged from the hospital without any neurological disturbance and their time to arrival ranged from one to 15 (9 +/- 5.8) min.Delayed arrival to the emergency room (15 min) associated with asystole were predictors of unsuccessful CPR, and both data are helpful in deciding when to stop CPR in subjects arriving at the emergency department with no out-of-hospital care.

To isolate novel ETS genes expressed in hematopoietic cells we used a nested, degenerate oligonucleotide PCR based technique to obtain a cDNA fragment that encodes an ETS domain from a human megakaryocytic cell line. This fragment was used to isolate a full length, 4.2 kb cDNA that encodes a 663 amino acid protein which we call MEF (myeloid elf-1-like factor). MEF contains a central ETS domain and is expressed in a variety of myeloid leukemia cell lines and in normal adult hematopoietic tissue such as spleen, thymus and peripheral blood, as well as non-hematopoietic tissue such as ovary, placenta and colon. Using an oligonucleotide binding selection assay, and bacterially expressed MEF, we demonstrated that MEF recognizes a consensus DNA binding sequence nearly identical to elf-1 (..WGGA..) and then showed that MEF specifically bound to known elf-1 binding sites in the human GM-CSF and IL-3 promoters. To characterize the functional effect of MEF on transcription, we performed co-transfection experiments in myeloid cells, and T cells, and demonstrated transactivation of both promoters by MEF, but not by elf-1. MEF is a new member of the elf-1/E74 family of ETS proteins, that has DNA binding properties similar to elf-1 but distinct transcriptional activating effects in several hematopoietic cell lineages.

To investigate the effects of prostaglandin I2 (PGI2) on cation regulation in vascular smooth muscle cells (VSMC), cAMP production, cytosolic free calcium concentration and cellular membrane Na+, K+ transporter activities were measured in the presence or absence of PGI2. The results were as follows. 1. PGI2 (10(-7) M) increased cAMP production, but had no effect on the cytosolic free calcium concentration of cultured VSMC. 2. PGI2 (10(-7), 10(-6) M) had no effect on ouabain-sensitive 86Rb uptake (Na+ -K+ pump activity) of cultured VSMC, but at a higher concentration (10(-5) M), PGI2 inhibited ouabain-sensitive 86Rb uptake. 3. PGI2 (10(-5) M) also inhibited 5-N, N hexamethylene amiloride (HMA)-sensitive 22Na uptake (Na+ -H+ antitransporter activity) of cultured VSMC in the presence of ouabain. 4. PGI2 (10(-5) M) had no effect on bumetanide-sensitive 86Rb washout (Na+ -K+ cotransporter activity) of cultured VSMC. These results suggest the possibility that PGI2 has a biphasic effect: PGI2 elicits relaxation at lower concentrations, but contraction at higher concentrations in cultured VSMC.

Cultured bovine and porcine trabecular cells were exposed to cyclic mechanical stretching, and their growth rates, morphological changes, and production of prostaglandin F2 (PGE2) and prostaglandin F2 alpha (PGF2 alpha) were examined. Cyclic mechanical stretching did not affect growth rates of the trabecular cells, but the cells became spindle-shaped in contrast to the stellate shape in the controls. The production of PGE2 by trabecular cells in the logarithmic growth phase decreased in response to cyclic mechanical stretching, but the production of PGF2 alpha increased significantly compared with the controls. The production of PGE2 and PGF2 alpha by the trabecular cells in the confluent stage was not different significantly from that in the controls. These findings indicate that trabecular cells might produce PGF2 alpha in the aqueous humor in response to changes in the intraocular pressure and have a role in regulating the intraocular pressure through relaxation of the ciliary muscle.

The anticancer drug distribution in pelvic arterial infusion chemotherapy with bilateral internal iliac arterial catheter placement with coil occlusion of the superior, inferior and obturator arteries was indirectly evaluated by serially performed DSA, CTA and RI on 18 patients with pelvic malignancies. The distribution was judged to be Excellent (E), defined as uniform distribution in the entire lesion alone, in 9 of 18 patients (50%) evaluated prior to the start of the arterial infusion (AI), and as Good (G), defined as uniform distribution in the entire lesion and partly on an unaffected portion, in 9 (50%). Of the 11 patients evaluated after 7 times AI, E was found in 3 patients (27%), G in 7 (64%) and Fair (F), defined as distribution with a defect in the lesion, in one patient (9%). Of the 11 patients evaluated after 14 AI, E was found in 5 (45%), G in 4 (36%) and F in 2 (18%). Of the 7 patients evaluated after 21 AI, E was found in 2 (29%), G in 4 (57%) and F in one (14%). G was found in 2 of 2 patients (100%) evaluated after 28 AI. These results suggest that this method can maintain a favorable anticancer drug distribution even after multiple sessions of AI.

Recently, interventional radiology (IVR) has been playing an important role as a treatment for the arterial occlusive diseases. Balloon angioplasty (PTA) is widely used for the stenotic lesions and clinical results are acceptable. However, some other procedures are frequently needed, and metallic stents (MS) are useful quite often. There are three main groups of stents: self-expanding stainless metallic stents (Z-stent, Wallstent), balloon-expandable stents (Palmaz stent, Strecker stent), and shape memory alloy stents, which are not clinically available for the iliac and femoro-popliteal arteries now in Japan except for Palmaz stent. However, it is expected that these MS will be available soon. In this paper we described the clinical utility of PTA and MS for the arterial occlusive diseases in the iliac and femoro-popliteal lesions based on our experience and past reports and also mentioned the future of IVR.

As chemoembolotherapy (TAE) for relatively small hepatocellular carcinoma (HCC) including small HCC of less than 2 cm in diameter, which is restricted to a sub-subsegment, subsegment or segment of the liver, segmental Lp-TAE using Lipiodol (Lp) mixed with an anticancer agent, which includes subsegmental and sub-sub-segmental therapy, not restricted to the tumor-bearing segment, is expected to move to the forefront of HCC treatments and also causes fewer complications and less strain to the patient. Of the 15 cases that underwent surgery following segmental Lp-TAE, complete necrosis was found histopathologically in more than 80% of the main tumor, satellite nodules in the embolized region and areas of capsular invasion. Its therapeutic efficacy for 51 cases with tumors smaller than 3 cm was comparable to that of surgery.

Susceptibilities of Enterococcus faecalis, Staphylococcus aureus, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa and Serratia spp. isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1994 to May 1995 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. No remarkable changes were found in susceptibilities of Citrobacter spp., Enterobacter spp. and Serratia spp. The susceptibilities of E. faecalis to amikacin and quinolones were better than those in 1993. As for S. aureus, susceptible strains to all drugs increased in uncomplicated UTIs. Against E. coli in 1993, the antimicrobial activities of piperacillin, cefotiam and aminoglycosides have decreased, however, in 1994, these activities have turned to the better state. As for Klebsiella spp. susceptible strains to ABPC decreased. The susceptibilities of P. mirabilis to all drugs except minocycline were good. Against P. aeruginosa in 1993, the activities of aminoglycosides have decreased, but, in 1994, these activities have turned to the better state. These data should be considered in clinical treatment of various urinary tract infections.

The usefulness of color Doppler sonography for the assessment of intrahepatic hemodynamics and shunt patency was evaluated in a total of eight patients in whom the intrahepatic hemodynamics before and after transjugular intrahepatic portosystemic shunt (TIPS) could be serially examined by color Doppler sonography. In six of these patients the serial sonographic examinations could be followed for more than one year after TIPS creation. Within one month after TIPS creation, Vmax in the shunt was ranged from 87 cm/sec to 242 cm/sec (mean: 142.5 cm/ sec), and the flow direction in the right anterior portal vein was reversed in all patients. More than 70% stenosis of the shunt could be diagnosed by color Doppler sonography. When the shunt was confirmed by angiography to be more than 70% stenotic or occluded, Vmax in the shunt was decreased to less than 50 cm/sec and the blood flow in the right anterior portal vein become hepatopetal. From three months before stenosis or occlusion of the shunt, it was confirmed that Vmax in the shunt was less than 70 cm/sec or the blood flow of right anterior portal vein was hepatopetal. Color Doppler sonography was useful for the assessment of intrahepatic hemodynamics, and shunt patency and prediction of shunt stenosis or occlusion following TIPS creation.